The successful operation to separate conjoined twins was one of the few high points in a difficult year for the health services, writes EITHNE DONNELLAN, Health Correspondent
THERE WAS the usual mix of protests over cuts to health services as well as controversies in 2010, but in a year when everyone had to search hard to find something to cheer about, the successful separation of a Cork couple’s conjoined twins brought a smile to everyone’s face.
News of the birth of the twin boys Hassan and Hussein Benhaffaf came in mid-January. A statement issued by the boys’ family announced they had been born six weeks earlier in a London hospital and were now being cared for at Cork University Maternity Hospital.
Two months later, the family travelled to Great Ormond Street Hospital in London and after 14 hours of surgery led by Cork-born Dr Edward Kiely on April 7th, the twins were successfully separated. They were conjoined at the chest area but did not share any vital organs. However, they will need one prosthetic limb each.
The boys arrived home on an Air Corps Casa aircraft in May and were met by jubilant scenes at Cork airport. Already celebrities in their own right, they recently turned on this year’s Christmas lights in Cork.
But there haven’t been such happy endings for all children in the State. As the twins arrived home, controversy was raging over the HSE’s inability to provide figures for Government on how many children died in its care over the past decade. The list was sought after the Government set up an independent review group to investigate the deaths of children while in State care. This followed publication of a leaked HSE report into the death of Tracey Fay (18), which severely criticised the childcare services for failing the teenager.
In mid-May, the HSE was saying 23 children had died in care up to the start of 2010, but by early June it had increased this figure to 37 children who had died in care from January 1st, 2000, to April 30th, 2010. The Minister of State for Children and Youth Affairs, Barry Andrews, criticised the time it took the HSE to hand over the figures, which he had requested in March.
By November, in a letter to the Dáil public accounts committee, the HSE revised the figure again, this time down from 37 to 35. After the initial debacle over the numbers, the HSE came in for scathing criticism from Ombudsman Emily O’Reilly, who accused the organisation of being riddled with secrecy and acting at times in its own self-interest.
During one investigation, her office was led on an “Alice in Wonderland trip” around the legal system as the HSE tried to prevent a report being published, she said. Her claims were refuted by the HSE which said it was acting on legal advice and only was abiding by the law.
In October came the publication of the Roscommon childcare report which outlined how a litany of failures by social workers and health service management led to six children enduring years of unnecessary abuse and neglect at the hands of their alcoholic parents, who are now in jail.
It found faulty decision-making; ineffective interdisciplinary working; ineffective assessment processes; weak management systems; a failure to learn from previous case reviews; and poor knowledge of childcare legislation contributed to the situation. The HSE issued a profuse apology.
It wasn’t the only time it had to say sorry during the year. It also had to apologise after news of yet another patient safety scandal at Our Lady of Lourdes Hospital in Drogheda emerged in June. This time it followed what it called a “serious near miss” involving Melissa Redmond from Donabate in north Co Dublin. When she attended the hospital for a scan eight weeks into her pregnancy in July 2009, she was advised there was no foetal heartbeat and that she had had a miscarriage. She was told to return for a DC procedure to have the “dead” child removed two days later and was given the abortive drug Cytotec to take on the morning of the operation.
The devastated mother of two, who had a number of previous miscarriages, couldn’t believe what she was hearing as she had an intrinsic feeling she was still pregnant. A visit to her GP confirmed the baby was very much alive and she gave birth to a healthy boy, Michael, in March this year.
When the findings of a review of her case were made public by Ms Redmond, showing the ultrasound machine was six years old and producing suboptimal images for very early pregnancy, and that there were “no permanent trained scan staff” attached to the early pregnancy unit, it prompted a flood of calls from other women who had had similar experiences at hospitals around the country. There were also calls from anxious women who had DCs and wondered if they should have sought second opinions beforehand. The HSE agreed to instigate a review of all misdiagnosed miscarriages in the past five years. This is ongoing.
In March, it emerged two cancer patients at Dublin’s Tallaght Hospital, one of whom had died, had a delayed diagnosis after their X-rays went unreported by consultant radiologists for some time. Making the announcement, the hospital admitted almost 58,000 X-rays taken over a four-year period at the hospital were never reviewed by a consultant radiologist. A review found staff shortages, which had been highlighted for years, was a major reason for the backlog.
Amid claims that X-rays were also going unreported at other hospitals, a separate review was set up by the HSE. Published earlier this month, it found a backlog of almost 34,000 X-rays had gone unreported by radiologists at other hospitals from 2008 to 2010. No additional adverse incidents were found when either backlog was reviewed.
Minister for Health Mary Harney, who was in New Zealand during much of the Tallaght X-ray saga, faced criticism for not cutting her trip short. But she survived this and other battles during the year, retaining her health portfolio during a subsequent Cabinet reshuffle. She also held her nerve after being splattered with red paint by a member of the socialist republican group Éirígí as she turned the sod for a new mental health facility in Ballyfermot in Dublin on November 1st, and after having her car pelted with eggs and cheese by protesters as she arrived at the Mid-Western Regional Hospital, Nenagh for an official function on November 12th.
She also found herself at the centre of a high-profile spat with the former chairman of the national childrens’ hospital development board Philip Lynch in October which resulted in his resignation and a reigniting of the row over the site for the new national children’s hospital. She claimed she sought his resignation but he insisted his decision to resign was his own.
Mr Lynch wasn’t the only significant figure to depart the health stage this year. In August, the HSE’s first chief executive Prof Brendan Drumm finished his five-year term and was replaced by the former Eircom chief Cathal Magee who was retained on a salary of €322,000, about €100,000 more than Ms Harney initially said the new chief executive would be paid.
The man responsible for the reorganisation of the State’s breast cancer services into eight designated centres also departed earlier this year. Prof Tom Keane, who was initially the preferred candidate to take over as the HSE’s new chief executive, withdrew from the competition in March after disagreements with the HSE board on how the job should be done. Ms Harney later claimed he withdrew for personal reasons. He has returned to Canada, from where he had been seconded for two years to head up the State’s national cancer control programme.
Another loss in 2010 came with the death in October of the pioneering heart surgeon and Irish Times HEALTHplus columnist Maurice Neligan. He died suddenly at his home in Dublin, aged 73 years, but goes down in medical history for having performed the first coronary artery bypass graft in Ireland in 1975 and Ireland’s first heart transplant in 1985. He also pioneered the development of open heart surgery in children.
But there were high points too in 2010. Internationally, a young Spanish man who had the world’s first full face transplant was discharged from hospital in July. The 31-year-old farmer had suffered dreadful facial disfigurement in a shooting accident five years ago which had left him unable to breathe, eat, swallow or speak properly.
And. in February. the prestigious medical journal, The Lancet, finally retracted from the public record a controversial research paper which linked the measles, mumps and rubella (MMR) vaccine with autism. The paper had resulted in a severe drop in vaccinations. The journal retracted the research following a General Medical Council fitness to practise ruling in the UK which found several elements of the 1998 paper by Dr Andrew Wakefield and others were incorrect.
Back at home, after protracted delays a contract for the development of a new unit with single rooms for cystic fibrosis patients at Dublin’s St Vincent’s hospital was signed in October. It is scheduled for completion in 2012.
And after months of concern about the proliferation of head shops the Government moved in May to declare a number of so-called “legal highs” illegal under the Misuse of Drugs Act and introduced tougher penalties for those in possession of or supplying the products ranging from seven years to life imprisonment. As news of the new laws emerged, many head shops began closing and clearing their shelves of the newly-banned substances.
Meanwhile, after years of concern that the HSE was overly bloated with administrators and managers, under an arrangement which saw nobody lose their jobs when all health boards were amalgamated, voluntary redundancy and early retirement schemes were put in place for up to 5,000 staff. Latest estimates suggest significantly fewer than that – about 2,975 – have now made up their minds to leave. This will reduce the HSE’s pay bill by more than €100 million a year, at a time when its budget will be cut by about 6.2 per cent to €13.4 billion for 2011.
In 2010, its budget was more than €14 billion, but this was still down about 5 per cent on a year earlier. HSE figures show it managed to see more patients this year than before despite the cuts, but not without letting many nurses on temporary contracts go, home help hours being reduced especially in the west, dental services for medical card holders being rationed, and around 1,000 hospital beds closed. There were cuts too to respite care services in June and July, but voluntary organisations whose own budgets had been slashed reversed the cuts following meetings with Government and a storm of public protest.
There were huge protests over the threat to remove services from a number of local hospitals under the HSE’s hospital reconfiguration plans, which may now be speeded up as a result of junior doctor shortages nationwide. Thousands turned out for protests in Wexford, Clonmel, Ballinasloe and Roscommon as well as more recently in Navan after the removal of keyhole and acute surgery from the town’s hospital.
Separately Hiqa, for the first time since it began inspecting all nursing homes, moved to de-register and close down two private nursing homes during the year, one in Wicklow, the other in Offaly, after serious concerns were raised for the health and welfare of their elderly residents.
Meanwhile, serious concerns for the welfare of elderly people living in their own homes and availing of unregulated home help services were raised by a Prime Time Investigates programme earlier this month. With the aid of undercover cameras it showed private homecare companies, often with money provided by the HSE, hiring untrained and unvetted home helps and homecare assistants as well as their care staff threatening older people, force-feeding them and stealing from them.
Taoiseach Brian Cowen apologised to families in the programme who had received a poor service and promised to look at regulating the sector. The HSE also promised to review the homecare provided to about 65,000 older people across the country.
Other investigations and reviews were also initiated, none more controversial in recent months than those into how millions were spent on foreign travel by senior trade union, HSE, Department of Health and Department of Finance officials using money from a fund established to provide training to lower paid health service staff. Some €2.3 million of the Skill funds resources were said to be sanctioned by the Department of Health and channelled through the HSE to Siptu over recent years but the union’s headquarters said it knew nothing about the bank account into which the money was paid. The HSE made a formal complaint to the Garda about money that could not be accounted for.
A HSE audit of the controversial Skill training programme in October found fundamental elements of internal control were not in place and that there were serious shortcomings in relation to governance, funding and foreign travel arrangements. But just as the Taoiseach was telling the Dáil that such waste could not be condoned medical card holders were having to pay prescription charges for the first time. These were introduced on October 1st, resulting in most medical card holders paying 50 cent per item prescribed, subject to a cap of €10 per month for each family.
The move, imposed even after an expert group found it was unlikely to raise enough revenue to justify the costs of administering the change, will be one of Ms Harney’s legacies. She said recently she will decide over the Christmas break whether or not to stand in the forthcoming election. Two of her Cabinet colleagues – Dermot Ahern and Noel Dempsey – have already said they will be throwing in the towel and she is odds-on to join them at the end of one of the most difficult years the health service as well as the country has faced.
HIGH POINTS
Successful separation of conjoined twins born to Cork parents.
Redundancy scheme finally announced for a bloated HSE.
New chief executive for the HSE.
End to swine flu pandemic.
Commencement of HPV vaccination campaign.
LOW POINTS
Introduction of prescription charges for medical card holders.
Departure of Prof Tom Keane.
Closure of about 1,000 hospital beds.
The baby scan scandal.
Disclosure that thousands of X-rays went unreported and GP referral letters weren’t processed at Tallaght .